This project will evaluate the relationships among distance to mammography, mammography utilization, and initial presentation of breast cancer in Vermont women. In addition to other factors, increasing distance to mammography has been shown to decrease mammography utilization for selected groups of women. Decreasing mammography utilization is associated with larger breast cancer tumor burden on presentation. This larger breast cancer tumor burden is associated with increased breast cancer mortality. We are interested in testing these associations among Vermont women ages 40-74. This project will use data from the Census 2000 and the Vermont Breast Cancer Surveillance System (VBCSS). The VBCSS, a statewide registry, collects mammography and breast pathology information from every mammography center and pathology facility within Vermont. The project consists of three aims: Aim 1: Is increasing distance to mammography associated with lower mammography use by Vermont women? Aim 2: How is distance to mammography associated with repeat mammography use after controlling for individual demographic and clinical characteristics? Aim 3: How is distance to mammography associated with initial presentation of breast cancer after controlling for individual demographic and clinical characteristics? If proven, the associations among distance to mammography, mammography utilization, and initial presentation of breast cancer have two policy implications. First, the associations would provide evidence that mammography decreases breast tumor burden at presentation. Second, health care policy makers would have an incentive to minimize the distance to mammography because of its effects on mammography utilization, initial presentation of breast cancer, and ultimately, breast cancer mortality.